Imerson v. District School Board

818 F. Supp. 1500, 1993 U.S. Dist. LEXIS 5223, 1993 WL 125143
CourtDistrict Court, M.D. Florida
DecidedApril 8, 1993
DocketNo. 92-203-CIV-T-17A
StatusPublished
Cited by2 cases

This text of 818 F. Supp. 1500 (Imerson v. District School Board) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Imerson v. District School Board, 818 F. Supp. 1500, 1993 U.S. Dist. LEXIS 5223, 1993 WL 125143 (M.D. Fla. 1993).

Opinion

ORDER ON MOTION FOR SUMMARY JUDGMENT

KOYACHEVICH, District Judge.

This cause is before the Court on the Motion for Summary Judgment (Dkt. # 30) filed by the Defendant, Anthem Life Insurance Company, as to Counts II and III of the Complaint. In Count II of the Complaint, Imerson asserts a cause of action against Anthem for breach of an insurance policy for failing to provide coverage. In Count III of the Complaint, Imerson seeks declaratory judgment defining the parties’ respective rights under the policy.

Summary judgment should only be entered when the moving party has sustained its burden of showing the absence of a genuine issue of material fact when all the evidence is viewed in a light most favorable to the non-moving party. Sweat v. Miller Brewing Co., 708 F.2d 655 (11th Cir.1983). All doubt as to the existence of a genuine issue of material fact must be resolved against the moving party. Hayden v. First National Bank of Mt. Pleasant, 595 F.2d 994, 996-97 (5th Cir.1979), quoting Gross v. Southern Railroad, Co., 414 F.2d 292 (5th Cir.1969).

The Supreme Court of the United States held in Celotex Corp. v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986):

In our view the plain language of Rule 56(c) mandates the entry of summary judgment after adequate time for discovery and upon motion against a party who fails to establish the existence of an essential element to that party’s case, and on which that party will bear the burden of proof at trial. Id. at 322, 106 S.Ct. at 2552, 91 L.Ed.2d at 273.

Rule 56(c) requires that the non-moving party go beyond the pleadings to designate specific facts showing there is a genuine issue for trial. Thus, affidavits, depositions, answers to interrogatories and admissions on file are all relevant in determining whether a motion for summary judgment should be granted. Id. at 323, 106 S.Ct. at 2553, 91 L.Ed.2d at 274.

I. Findings of Fact

Thomas Imerson, father of the Plaintiff, Todd G. Imerson, was insured under a group policy issued by the Gulf Life Insurance Company to the District School Board of Pasco County, Florida. Thomas Imerson elected to cover himself and his dependents under the Policy in January of 1987. Since the issuance of the Policy, Thomas Imerson, has paid the premiums necessary for coverage.

According to the terms of the Policy, a dependent means “your spouse or your unmarried child from birth but under 19 years of age.” The policy then sets forth the following exception to the age requirement:

... your unmarried dependent children enrolled as full time students at an accredited school or college are eligible until attainment of 23 years of age.

Furthermore, the terms of the Policy state that dependent insurance will terminate on the earliest of:

(e) the date coverage for dependents is terminated under the Group Policy, or
(d) for any dependent, the date he ceases to be an eligible dependent.
[1502]*1502Eligibility as a dependent will cease ... (c) for your child on the date of the child’s marriage or attainment of the maximum applicable age limit, whichever is the earliest date.

On January 20, 1990, Plaintiff Imerson, turned nineteen years of age. At that time, he was not enrolled as a full-time student. Approximately six months later, on July 22, 1990, Imerson presented himself at a walk-in clinic with chest pain. Two days later, Imerson applied for admission to St. Petersburg Junior College and paid a $20.00 application fee. On July 27, 1990, Imerson was considered “admitted” to the college. However, as part of the registration process, Plaintiff Imerson, still had to attend counseling, take the placement test, and register for specific classes.

On July 31, 1990, four days after Imerson was considered enrolled at the college, he was diagnosed as suffering from a heart disorder and was hospitalized. Ultimately, on August 15, 1990, he underwent heart transplant surgery. As a result of Plaintiff Imerson’s medical condition, he was unable to attend counseling, take the placement test and register for classes. If Plaintiff Imerson had been able to complete the registration process, it was his intention to take 'twelve credit hours as a full-time student. In fact, after Plaintiff Imerson’s medical discharge, he returned to St. Petersburg Junior College in November of 1990 and attended counseling, took the placement test and registered for twelve credit hours.

Following Plaintiff Imerson’s surgery, medical bills were submitted to the Defendant, Anthem Life. Anthem, upon receiving the medical bills, denied coverage on the grounds that Imerson’s coverage was automatically terminated on January 20, 1990 when Plaintiff Imerson turned nineteen. Furthermore, Anthem contends that Imerson was not a full time student at the time of his sickness and alleges that even if Plaintiff Imerson is considered enrolled as a full time student he is not automatically reinstated under the Policy.

II. Discussion

A. The insurance policy is clear and unambiguous

When the language of an insurance policy is clear and unambiguous, the policy must be enforced as written. Stuyvesant Ins. Co. v. Butler, 314 So.2d 567, 570 (Fla.1975). The policy at issue in this case clearly and unambiguously states that a dependent is an “unmarried child from birth but under 19 years of age.” Furthermore, the policy clearly states that the age limitation does not apply for “unmarried dependent children enrolled as full time students at an accredited school or college”. In this circumstance, full-time students are eligible for coverage until “attainment of age 23.”

Plaintiff argues that the policy is ambiguous and should therefore be construed against the insurer and in favor of the insured. Id. Specifically, the Plaintiff contends that an ambiguity exists in the section entitled “Termination of Individual Insurance.” This section provides that eligibility will cease “for your child, on the date of the child’s marriage or attainment of the applicable maximum age limit.” Plaintiff states that this clause when read in combination with the definition of dependent creates an ambiguity in that the maximum applicable age can be seen as 23 and not 19. However, the clear and unambiguous definition of “dependent” when read in conjunction with the termination clause clearly sets forth two age limitations.

First, if the dependent turns 19 and is not enrolled as a full time student, his coverage will cease. Under this scenario, the maximum applicable age limit is 19. Second, if the dependent turns 19, is unmarried and enrolled as a full time student, the dependent will be eligible for coverage until he reaches the age of 23. Thus, under this scenario, the maximum applicable age limit is 23.

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Bluebook (online)
818 F. Supp. 1500, 1993 U.S. Dist. LEXIS 5223, 1993 WL 125143, Counsel Stack Legal Research, https://law.counselstack.com/opinion/imerson-v-district-school-board-flmd-1993.